Delayed childbearing and the outcome of pregnancy

Article Abstract:

Women are delaying the birth of their first child until increasingly later ages, giving added importance to the question of whether babies born to these older mothers are less healthy. Studies of this subject have provided conflicting reports; some find adverse effects on infant and maternal health, while others report no higher risk of undesirable outcomes for older women. Maternal and newborn health were assessed in 3,917 private female patients 20 years of age or older who delivered their first baby. Several factors were noted, including rate of delivery of low-birth-weight babies (less than 2500 g, or 5.5 lbs) and babies small for their gestational age, infant mortality, and complications before and after delivery. The number of caesarean births, frequency of low Apgar scores (an index of the infant's physical condition at the time of birth), and number of admissions to the newborn intensive care unit were also recorded. Characteristics of the mother such as age, race, marital status, educational level, and habits such as smoking were correlated with the birth data. Results showed no effect of maternal age on preterm delivery of infants or on the delivery of small-for-gestational-age infants. There was a slight trend toward an increased risk of delivery of low-birth-weight infants. Infant mortality in the perinatal period was no higher for children of older mothers. On the other hand, higher rates of maternal complications before and during delivery for these older women were found, with the highest rates among women over 35. Such complications included gestational diabetes, pregnancy-induced hypertension, gestational bleeding, abruptio placentae (an abrupt detachment of the placenta), and placenta previa (placenta located so that it covers the opening of the uterus). Some other complications, such as anemia, premature labor, and incompetent cervix were not more frequent among these women. Women over 30 underwent caesarean section more often than younger mothers. Finally, babies of the older mothers had a slightly higher rate of admission to the newborn intensive care unit. Taken as a whole, the results indicate no increased risks to babies delivered to older mothers, but there is increased maternal risk from a variety of conditions. The women studied were predominantly white, married, non-smokers, and college-educated and the findings may not be applicable to all population subgroups. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Pregnancy, Pregnancy, Complications of, Pregnancy complications, Maternal age

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Invasive studies during normal pregnancy

Article Abstract:

This review of the ethical aspects of performing experiments on pregnant women was prompted by an article by Pivarnik and colleagues published in the June 1990 issue of Obstetrics and Gynecology. The research examined the effects of exercise on normal pregnancy, while catheters were placed in the arteries of healthy pregnant women. There is no other branch of medicine that relies so heavily on research about normal physiology than obstetrics. An important ethical issue is how physicians, who usually go to great lengths to protect the mother and fetus, are willing to subject pregnant women to invasive procedures such as the catheter placement. If a study carries very little risk of harm to the mother and fetus, it is reasonable to conduct it. In cases in which data is obtained using invasive methods, the study should meet the following criteria. The risks must be extremely low, and those risks must be described clearly and thoroughly to the pregnant woman, and if possible to the baby's father as well. Although the participants themselves do not have to benefit directly from the research, the end result must be of direct benefit to other patients. Lastly, a board composed of a mixture of people from a variety of backgrounds, including both the scientific and lay communities, should evaluate whether the study is ethically sound. It is argued that although pulmonary catheterization carries a low risk when performed by skilled practitioners, and is seemingly ethically sound, the study in question could have obtained similar information without using such invasive methodology. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Ethical aspects, Pregnant women, Human experimentation in medicine, Human medical experimentation, Informed consent (Medical law), Informed consent, Medical ethics, editorial

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Placental Abruption and Adverse Perinatal Outcomes

Article Abstract:

Placental abruption during pregnancy may increase the risk of stillbirth, premature birth and fetal growth restriction. Placental abruption, sometimes called abruptio placentae, occurs when the placenta separates from the uterine wall. In a study of 40,789 women, 530 (1%) had a placental abruption during pregnancy. These women were 9 times more likely to have a stillbirth, 4 times more likely to deliver prematurely and twice as likely to have a growth-restricted baby. The risk of stillbirth was 30 times higher in women with at least a 50% placental separation.

Fetal growth retardation, Premature birth, Abruptio placentae, Placental abruption, Still-birth, Stillbirth

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